Provider Demographics
NPI:1568132389
Name:OVERTON, JAJAIRA T (LPN)
Entity Type:Individual
Prefix:MRS
First Name:JAJAIRA
Middle Name:T
Last Name:OVERTON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:NH
Mailing Address - Zip Code:03079-2711
Mailing Address - Country:US
Mailing Address - Phone:603-893-7064
Mailing Address - Fax:603-893-7065
Practice Address - Street 1:24 SCHOOL ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:NH
Practice Address - Zip Code:03079-2711
Practice Address - Country:US
Practice Address - Phone:603-893-7064
Practice Address - Fax:603-893-7065
Is Sole Proprietor?:No
Enumeration Date:2021-09-14
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH017926-22164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse